National Association of Attorneys General Urges Congress to Prohibit PBM-Owned Pharmacies
On behalf of 39 state and territory attorneys general, the National Association of Attorneys General issued a letter to Congress regarding major PBMs’ conflicts of interest.
The National Association of Attorneys General (NAAG) issued a letter to Congress calling for the prohibition of pharmacy benefit managers’ (PBM) ability to own and operate affiliated pharmacy businesses. The NAAG issued its letter on behalf of 39 state and territory attorneys general looking to limit the “outsized power” of PBMs, according to a news release.1
“Pharmacy Benefit Managers serve as third-party administrators for prescription drug programs within health plans,” stated authors of the letter. “Over the years, both horizontal consolidation and vertical integration have shifted PBMs from being helpful administrative service providers to market-dominating giants that control the industry. Each of the 6 largest PBMs has its own affiliated pharmacies, and 5 of these major players are also associated with parent companies that manage insurance firms and health care clinics.”
With a new presidential administration nearly 3 months into its first year, conversations with Congress and pleads to lawmakers in DC have reemerged regarding federal PBM reform. Before the new administration took office, however, a year-end spending plan that included PBM reforms was pulled for a less expensive package.2
Since last year, new government officials have taken office and PBM reform has a whole new set of eyes on it within Congress. | image credit: Picturellarious / stock.adobe.com
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Since the end of 2024, new government officials have taken office and PBM reform has a whole new set of eyes on it within Congress. One of the newest lawmakers to recently take office was Robert F. Kennedy Jr., who was confirmed as Secretary of the US Department of Health and Human Services in February and has relayed that this new administration is “committed” to ensuring PBM reform.3,4
As all of these sentiments are presented to the public, federal PBM reform has yet to be passed in 2025, leading advocates who have felt the pressures of PBM control to continuously call for industry-wide change.
“By owning affiliated pharmacies, PBMs exert influence over their competitors, using their intermediary role to impose conditions that disadvantage independent pharmacies,” continued the NAAG news release.1 “This often forces these small businesses to accept complex, unjust, arbitrary, and detrimental contractual agreements.”
The pharmacists’ role within pharmacy benefits distribution has been noticeably demoralized as industry experts further uncover financially harmful PBM practices. These issues then spill into the pockets of patients, which the NAAG attorneys general focused on in their letter to Congress.
“PBMs have overtaken the market and now wield outsized power to reap massive profits at the expense of consumers,” stated the letter, according to the NAAG release. “The rise of PBMs as middlemen in the prescription drug market has resulted in patients facing fewer choices, lower quality care, and higher prices.”
While attorneys general from across the US are banning together to end PBM ownership of pharmacies, it’s not the first instance of lawyers and other lawmakers attempting to forbid PBMs’ conflicts of interest. In late 2024, before Congress’ pull-back of PBM reform, Senators Elizabeth Warren (D, Massachusetts) and Josh Hawley (R, Missouri) introduced a bipartisan bill coming out of the House. Titled “Patients Before Monopolies,” or the PBM Act, this bill was designed to put an end to the aforementioned conflicts of interest and separate the businesses of pharmacy and benefits distribution.5
As PBM reform advocates continue to enforce momentum on the federal level, US states are also focusing on limiting these conflicts of interest and taking the power away from pharmaceutical middlemen.
One of the more notable efforts for state-level PBM reform was that of Representative Phillip Rigsby (R, Alabama), an independent pharmacy owner who played a crucial role in his state’s passing of the Community Pharmacy Relief Act, which occurred in early April 2025.
“There have been many ups and downs in this journey, and there were days I wanted to throw in the towel, but I realized that my flesh was telling me to quit,” said Rigsby, according to the Alabama Reflector.6 “Thanks be to God. When I felt defeated, that’s when my faith reminded me.”
Arkansas Governor Sarah Sanders also recently signed a bill forbidding PBMs in her state from owning and operating pharmacies.7
“All 3 of the PBMs, especially Express Scripts, are trying to do a lot of smoke and mirrors to convince Congress that there's nothing to see—everything's okay with independent pharmacies,” Douglas Hoey, RPh, MBA, CEO of the National Community Pharmacists Association, told Drug Topics in a recent interview.8 “We've solved it through the marketplace, which is the way everyone would like to solve the problems between PBMs and pharmacies. We need legislation, because the marketplace is so tilted, it's so one-sided in the PBMs’ favor that, unfortunately, the marketplace doesn't work anymore.”
Many experts and pharmacy professionals believe PBM control in the pharmaceutical market has reached a boiling point that can be detrimental to the industry. With many talks of industry-change focusing on the need for congressional intervention, PBM reform advocates will continue to play the waiting game in terms of federal-level change.
“Congressional action is warranted to restore a free market and protect consumers and small businesses,” concluded the NAAG’s letter.1 “As self-designated middlemen, PBMs should not be permitted to own or operate affiliated pharmacies.”
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